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2. Organization Name*
4. Type of Activity*
6. Percentage of South Jordan Residents that Participate in the Program
10. Contact Person*
12. Phone*
13. Email
15. Address*
17. City*
18. State*
19. Zip Code*
23. Field Requested (First Preference)*
24. Field Requested (Second Preference)
26. Requested Start / End Dates*
    Requested Start / End Dates Start Date

    —

    Requested Start / End Dates End Date

    Note that fields are only available April 1, 2023 to October 14, 2023

28. Requested Reservation Days / Times
30. Sunday
    Sunday Start Time

    —

    Sunday End Time
32. Monday
    Monday Start Time

    —

    Monday End Time
34. Tuesday
    Tuesday Start Time

    —

    Tuesday End Time
36. Wednesday
    Wednesday Start Time

    —

    Wednesday End Time
38. Thursday
    Thursday Start Time

    —

    Thursday End Time
40. Friday
    Friday Start Time

    —

    Friday End Time
42. Saturday
    Saturday Start Time

    —

    Saturday End Time
44. Estimated Number of Participants*
46. Additional Notes and/or Special Requests
50. Notes for Approved Field Reservation Requests
    • Once a field reservation request is reviewed and accepted, requester will be notified and sent a draft field use agreement (contract example attached).
    • Requestor will have 5 business days to review written agreement, request changes, submit any required occupational licenses, competency cards, or certificates necessary for the administration of programs carried out on fields reserved, and submit required certificates of insurance.
    • Once required documents are received and written agreement is deemed acceptable to both the requestor and the city, a copy of the agreement will be emailed to both parties for digital signatures.
    • Those who reserve field space will be required to independently comply with H.B. 204 "Protection of Athletes with Head Injuries" and certify compliance.
    • Please note, you may be asked to provide proof of South Jordan City resident participation percentages.
    • Please note the field use insurance requirements listed below:
      • User shall, at User's sole cost and expense and throughout the term of this Agreement and any extensions thereof, carry:
        • Workers compensation insurance adequate to protect User from claims under workers compensation acts.
        • General personal injury and property damage liability insurance and automobile liability insurance with liability limits of not less than $2 million each occurrence and $3 million aggregate for the injury or death of person or persons and property damage.
      • All insurance policies shall be issued by a financially responsible company or companies authorized to do business in the State of Utah. User shall provide City with copies of certificates for all policies with an endorsement that they are not subject to cancellation without 30 days prior written notice to City and the City, its officers and employees, shall be named as additional insured on General and Automobile liability policies only.
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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field